Zhongxin Finance, April 8. Recently, the National Medical Security Administration recently issued the "Administrative Measures for the Intelligent Audit and Monitoring Knowledge Base and Rule Base of Medical Security Funds (Trial)".
It is clear that the medical security department relies on the "two banks" to monitor the whole process of the use of medical security funds by various supervised objects in various scenarios.
Among the two databases, the knowledge base is the collection of knowledge and basis required for the intelligent audit and monitoring of the medical security fund; the rule base is the logic, parameter indicators, reference thresholds, and judgment levels for judging the legality and compliance of the relevant behaviors of the supervised objects based on the knowledge base. collection.
The "Measures (Trial)" clarifies that medical security agencies use the "two databases" to carry out business management activities such as advance reminders, payment review, agreement assessment, and auditing of medical insurance fee settlement.
Medical security administrative departments and institutions engaged in medical insurance administrative law enforcement use the "two libraries" to assist in medical insurance administrative supervision and administrative law enforcement related activities.
Encourage designated medical institutions to use the "two banks" to strengthen internal management and standardize medical service behavior.
The "Measures (Trial)" stipulates that provincial and prefecture-level medical security departments should establish and improve internal management mechanisms, and formulate procedures for handling suspicious information.
The handling procedures shall include initial review, re-examination, appeals from supervision objects, investigation and verification, and handling of violations, etc., and a reasonable time limit shall be set for each link.
Medical security departments and third-party technical information service agencies and their staff should strictly regulate data management and application in the construction and management of the "two databases", earnestly fulfill their confidentiality obligations, and shall not illegally provide, copy, publish, Sell or disguised transaction data to ensure data security.
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